Access to contraception and mental healthcare services is critical to empowering women in SA’s rural areas

The severe consequences of early pregnancy include increased maternal mortality, educational disruption, economic hardship and social stigma. Similarly, the mental health impact of gender-based violence (GBV) has devastating effects on women survivors.

Early pregnancy has far-reaching implications for the mother, her child, their family and society at large. Teenage pregnancy has, for example, been shown to result in girls on average dropping out of school earlier. With adolescent pregnancy and birth rates increasing in South Africa, the situation seems to be getting worse.

Poorer access to sexual and reproductive health services in rural areas means women who live in these areas are at higher risk of early pregnancy and related negative outcomes. The negative sociocultural factors prevalent in rural areas, such as the lack of access to contraceptives, limited financial means and social stigma surrounding pregnancy and contraceptive use, exacerbates women’s lack of access to sexual and reproductive healthcare services. We discussed these and other factors in more detail in a recent policy brief.

To see things in context, early pregnancy should be considered alongside other realities that many young women face, particularly GBV and its mental health consequences. GBV has a strong association to patriarchal ideologies which are fertile in rural areas due to the ingrained cultural norms of male dominance.

In the past few years, South Africa has reported more than 50,000 sexual assaults. Data from an analysis of three national surveys shows that largely rural provinces such as the Eastern Cape, KwaZulu-Natal and North West have the highest number of cases of femicide – the murder of women, based on their gender. This underscores the significant challenges the country encounters in tackling GBV. Even more concerning is that many of these GBV cases against women are at the hands of their partners.

Women survivors of GBV are at high risk of mental illness such as depression and post-traumatic stress disorder. The negative impact on the mental health of GBV women survivors is exacerbated by the reality that the necessary mental healthcare services are often not available or accessible, particularly for women in rural areas, leaving them to deal with the impact of GBV on their mental health on their own.

The issues of early pregnancy and GBV are deeply intertwined. For example, when young girls in rural areas are not able to access contraceptives, their risk of early pregnancy increases, and with that their risk of dropping out of school. This coupled with the lack of employment opportunities for women severely limits their life choices and increases their vulnerability to GBV and its mental health consequences.

What can be done?